Service Request Form

For any questions, please contact ARPwave via phone at (952)431-9708 or via email at [email protected]

Date (mm-dd-yyyy)

Unit Type

Clinic or Therapist Name (If Applicable)

Name *

First

Last

Email *

Phone *

Street Address *

City *

State *

Zip Code *

Country (If outside the USA)

Unit Serial Number *

Credits Remaining (If Applicable)

Detailed Description of The Problem

If this is an issue with an accessory please contact the ARPwave office at (952)431-9708

Shipping Preference

Please note that if your device is within the warranty period, you will be responsible for shipping the unit to ARPwave, and ARPwave will cover the return shipping. If your device is outside of it's warranty period, you will be responsible for shipping both ways.

"Ship To" Address if Different Than Above

Loaner Requested

Yes
Not Interested

Loaners available based upon availability. Fees may apply.

Additional Comments

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